4 Types Of Constipation - Quick Explainer Guide
When it comes to constipation, the most common type is normal transit constipation. However, in other cases there are rare but specific subtypes of constipation. These types are taken into consideration when constipation remains unresponsive to simple remedies and treatments, which we will explain later on in this guide. Let's go!

Table of Contents
Primary CC has four broad, and overlapping, subtypes:
- Normal transit constipation (most common)
- Slow transit constipation (STC)
- Evacuation disorders (EDs)
- Mixed type CC (6)
And we are here to break them down for you from what it is, to its differentiating pathophysiology, and diagnosis criteria.
Normal Transit Constipation: |
What is it:
|
Pathophysiology
|
Diagnosis
|
Slow Transit Constipation: |
What is it:
|
Pathophysiology
|
Diagnosis
|
Pelvic Floor / Evacuation Disorders |
What is it:
|
Pathophysiology
|
Diagnosis
|
Mixed type (eg slow transit + pelvic floor disorders) |
What is it:
|
Prevalence of CC subtypes
Of the three primary forms of constipation, Nyam’s study evaluating over 1,000 patients showed 59% had normal colonic transit and normal pelvic floor function, 25% had pelvic floor dysfunction, 13% had STC and 3% had miSTC and pelvic floor dysfunction (9).
What is the difference between IBS-C vs Chronic Constipation?
The symptom based criteria for CC with normal transit time, noted above, often overlaps with IBS with constipation (IBS-C).
Constipation-predominant IBS is typically defined using the Rome III criteria and is characterized by abdominal pain or discomfort associated with infrequent or difficult defecation (15). Studies show that the brain response to visceral distention or even anticipation of pain is increased in individuals with IBS symptoms (15).
Therefore, the American College of Gastroenterology CC Task Force emphasizes that the presence of clinically important abdominal discomfort associated with constipation symptoms differentiates a spectrum between IBS-C from CC (4).
CC patients typically report minimal abdominal bloating or discomfort (4). Unfortunately, IBS-C and normal transit CC is largely based on opinion and in some patients with CC it may be difficult, if not nearly impossible, to make this distinction accurately (4).
Below are some IBS-C targeted self-assessment questions that may be helpful in distinguishing between the spectrum of IBS-C and CC symptoms.
IBS-C targeted self-assessment questions:
- Is your abdominal pain (or discomfort) relieved by deduction?
- At the onset of abdominal pain or discomfort, are your stools looser or harder?
- When the abdominal pain (or discomfort) begins, do you have more (or less) frequent stools?
Our Summary
- Primary CC has four broad, and overlapping, subtypes:
- Normal transit constipation (most common)
- Slow transit constipation (STC)
- Pelvic Floor or Evacuation disorders (EDs)
- Mixed type CC
- Normal Transit Constipation
- Characterized by muscles in the colon still functioning properly (not too fast or too slow) and bowel movements are at the right speed but still, your stool may be too hard or difficult to pass.
- Slow transit Constipation
- Characterized by reduced motility, delayed movement, of the stool through the large intestines due to an underlying dysfunction and abnormality of the colonic smooth muscle or neuropathy.
- Pelvic Floor or Evacuation Disorders
- Characterized by inability or difficulty to correctly relax and coordinate the abdominal and anorectal muscles (pelvic floor muscles) to have the ‘final push’ for complete stool evacuation from the rectum.
- Differentiating CC from IBS-C symptoms can be difficult and it's often largely based on opinion; however, it is emphasized that the presence of clinically important abdominal discomfort and pain associated with constipation symptoms differentiates a spectrum between IBS-C from CC.
Evidence Based
An evidence hierarchy is followed to ensure conclusions are formed off of the most up-to-date and well-designed studies available. We aim to reference studies conducted within the past five years when possible.
- Systematic review or meta-analysis of randomized controlled trials
- Randomized controlled trials
- Controlled trials without randomization
- Case-control (retrospective) and cohort (prospective) studies
- A systematic review of descriptive, qualitative, or mixed-method studies
- A single descriptive, qualitative, or mixed-method study
- Studies without controls, case reports, and case series
- Animal research
- In vitro research
References
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